Transformation of provider-patient relationships will be essential to the success of efforts to achieve patient-centered care, as envisioned in the IOM report, Crossing the Quality Chasm. This research will investigate new ways of structuring doctor-patient relationships by studying five innovative practices: 1 ) cancer self-help and advocacy, 2) palliative care, 3) complementary medicine, 4) group visits for chronic illness care, and 5) new communications curricula in medical education. Three research questions will be addressed through study of each of these cases: 1. How can doctor-patient relationships be restructured within the following dimensions to promote patient-centered care: exercise of authority, distribution of responsibility among patients and providers, patient access to expertise, the range of patient needs addressed, affective involvement of both parties, possibilities for authenticity, and maintenance of trust? 2. What are the critical elements that promote or impede application of these innovations in medical practice? How can relationships be reformulated to optimally address specific health problems or serve distinctive patient populations? 3. How do the new possibilities for structuring relationships posed by these cases accord with dominant theoretical perspectives on doctor-patient relationships? How might existing models be revised to more effectively guide future research? A qualitative research approach serves the overall goal of developing new models in unexplored territory. In-depth interviews will be conducted with participants in each case and inductively analyzed to: a) study the dynamics of caring focusing on those features central to effectiveness; b) compare these features across cases and in relation to prevailing models of doctor-patient relationships; c) assess conditions under which each innovation functions, its acceptability to population subgroups, and the potential to expand its application more broadly; and d) generate hypotheses about promising changes in mainstream relationships and approaches for achieving them. The study is designed, first, to illuminate new possibilities for structuring doctor-patient relationships consonant with IOM's agenda for redesign of health care processes. Second, findings will inform initiatives in medical education as a vehicle for preparing doctors to assume new roles. Third, development of new conceptual frameworks and models will guide future research on the impact of doctor-patient relationships on quality of care.
